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Sugar Separation Test By Chromatography

Virginia rates for HCPCS 84375

Separates the different sugars present in a sample so that each can be identified on its own, using a technique that spreads them out across a plate or paper according to how they travel. It is used when a person may not be digesting or handling particular sugars normally, including in the investigation of inherited disorders of sugar metabolism.

Rates data updated July 2026.

Facilitymedian $42 · 10th–90th $28$1660%20%10th90th$42Professionalmedian $30 · 10th–90th $15$580%20%40%10th90th$30$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$29.51
Median
$74.13
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$29.51
Typical High
$45.71
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$154.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$15.49
Typical High
$26.30
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$93.33
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$67.61
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$19.95
Typical High
$38.90
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$46.77
Typical High
$57.54
Medcost
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$33.11
Typical High
$38.02
Medcost
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$28.18
Typical High
$33.11
Medcost
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$16.98
Typical High
$81.28
Sentara
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$46.77
Typical High
$10,000.00
Sentara
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$46.77
Typical High
$10,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$38.90
Typical High
$46.77
United
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$16.22
Typical High
$23.44